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John C. Morris - One of the best experts on this subject based on the ideXlab platform.
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item response theory analysis of the Clinical Dementia Rating
Alzheimers & Dementia, 2020Co-Authors: Chengjie Xiong, Andrew J Aschenbrenner, Chihhung Chang, Michael W Weiner, Rachel L Nosheny, Dan M Mungas, Randall J Bateman, Jason Hassenstab, Krista L Moulder, John C. MorrisAbstract:Introduction The Clinical Dementia Rating (CDR) is widely used in Alzheimer's disease research studies and has well established reliability and validity. To facilitate the development of an online, electronic CDR (eCDR) for more efficient Clinical applications, this study aims to produce a shortened version of the CDR, and to develop the statistical model for automatic scoring. Methods Item response theory (IRT) was used for item evaluation and model development. An automatic scoring algorithm was validated using existing CDR global and domain box scores as the reference standard. Results Most CDR items discriminate well at mild and very mild levels of cognitive impairment. The bi-factor IRT model fits best and the shortened CDR still demonstrates very high classification accuracy (81%∼92%). Discussion The shortened version of the CDR and the automatic scoring algorithm has established a good foundation for developing an eCDR and will ultimately improve the efficiency of cognitive assessment.
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adaptation of the Clinical Dementia Rating scale for adults with down syndrome
Journal of Neurodevelopmental Disorders, 2019Co-Authors: Christina N Lessovschlaggar, John C. Morris, Olga L Del Rosario, Beau M Ances, Bradley L Schlaggar, John N ConstantinoAbstract:Adults with Down syndrome (DS) are at increased risk for Alzheimer disease Dementia, and there is a pressing need for the development of assessment instruments that differentiate chronic cognitive impairment, acute neuropsychiatric symptomatology, and Dementia in this population of patients. We adapted a widely used instrument, the Clinical Dementia Rating (CDR) Scale, which is a component of the Uniform Data Set used by all federally funded Alzheimer Disease Centers for use in adults with DS, and tested the instrument among 34 DS patients recruited from the community. The participants were assessed using two versions of the modified CDR—a caregiver questionnaire and an in-person interview involving both the caregiver and the DS adult. Assessment also included the Dementia Scale for Down Syndrome (DSDS) and the Raven’s Progressive Matrices to estimate IQ. Both modified questionnaire and interview instruments captured a range of cognitive impairments, a majority of which were found to be chronic when accounting for premorbid function. Two individuals in the sample were strongly suspected to have early Dementia, both of whom had elevated scores on the modified CDR instruments. Among individuals rated as having no Dementia based on the DSDS, about half showed subthreshold impairments on the modified CDR instruments; there was substantial agreement between caregiver questionnaire screening and in-person interview of caregivers and DS adults. The modified questionnaire and interview instruments capture a range of impairment in DS adults, including subthreshold symptomatology, and the instruments provide complementary information relevant to the ascertainment of Dementia in DS. Decline was seen across all cognitive domains and was generally positively related to age and negatively related to IQ. Most importantly, adjusting instrument scores for chronic, premorbid impairment drastically shifted the distribution toward lower (no impairment) scores.
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progression of alzheimer s disease as measured by Clinical Dementia Rating sum of boxes scores
Alzheimers & Dementia, 2013Co-Authors: Monique M. Williams, Catherine M. Roe, Martha Storandt, John C. MorrisAbstract:Abstract Background This study examined rates of Dementia progression as ascertained by the Clinical Dementia Rating Sum of Boxes (CDR-SB) for symptomatic Alzheimer's disease (sAD), and assessed participant characteristics as predictors of CDR-SB progression. Methods Participants (n = 792) were enrolled in longitudinal studies at an Alzheimer's Disease Research Center, received a diagnosis of sAD with a global CDR of 0.5 (n = 466) or 1 (n = 326), and had at least one follow-up assessment. Progression in CDR-SB over time as a function of baseline global CDR was examined. Results A longitudinal increase ( P P Conclusions The study findings are relevant to sAD Clinical trial design and accurate, reliable ascertainment of the effect of disease-modifying treatments.
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Progression of Alzheimer’s disease as measured by Clinical Dementia Rating Sum of Boxes scores
Alzheimers & Dementia, 2012Co-Authors: Monique M. Williams, Catherine M. Roe, Martha Storandt, John C. MorrisAbstract:Abstract Background This study examined rates of Dementia progression as ascertained by the Clinical Dementia Rating Sum of Boxes (CDR-SB) for symptomatic Alzheimer's disease (sAD), and assessed participant characteristics as predictors of CDR-SB progression. Methods Participants (n = 792) were enrolled in longitudinal studies at an Alzheimer's Disease Research Center, received a diagnosis of sAD with a global CDR of 0.5 (n = 466) or 1 (n = 326), and had at least one follow-up assessment. Progression in CDR-SB over time as a function of baseline global CDR was examined. Results A longitudinal increase ( P P Conclusions The study findings are relevant to sAD Clinical trial design and accurate, reliable ascertainment of the effect of disease-modifying treatments.
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Progression of Alzheimer's disease as measured by Clinical Dementia Rating Sum of Boxes scores.
Alzheimer's & dementia : the journal of the Alzheimer's Association, 2012Co-Authors: Monique M. Williams, Catherine M. Roe, Martha Storandt, John C. MorrisAbstract:This study examined rates of Dementia progression as ascertained by the Clinical Dementia Rating Sum of Boxes (CDR-SB) for symptomatic Alzheimer's disease (sAD), and assessed participant characteristics as predictors of CDR-SB progression. Participants (n = 792) were enrolled in longitudinal studies at an Alzheimer's Disease Research Center, received a diagnosis of sAD with a global CDR of 0.5 (n = 466) or 1 (n = 326), and had at least one follow-up assessment. Progression in CDR-SB over time as a function of baseline global CDR was examined. A longitudinal increase (P < .0001) in CDR-SB was observed. The annual rate of change in CDR-SB scores was 1.43 (standard error [SE] = 0.05) in the CDR 0.5 sample and 1.91 (SE = 0.07) in the CDR 1 sample. For participants followed from the beginning of the CDR stage, time to progression to a higher global CDR was longer for individuals who were CDR 0.5 (3.75 years; 95% confidence interval [CI]: 3.18-4.33) than those who were CDR 1 at baseline (2.98 years; 95% CI: 2.75-3.22). In the total CDR 0.5 sample, the significant predictors of progression to the next global CDR stage (P < .01) were age at first sAD diagnosis and apolipoprotein E4 genotype. The study findings are relevant to sAD Clinical trial design and accurate, reliable ascertainment of the effect of disease-modifying treatments. Copyright © 2013 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.
Deborah Blacker - One of the best experts on this subject based on the ideXlab platform.
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The SIST-M: Predictive validity of a brief structured Clinical Dementia Rating interview
Alzheimer disease and associated disorders, 2012Co-Authors: Olivia I. Okereke, Norberto Pantoja-galicia, Maura Copeland, Bradley T. Hyman, Taylor Wanggaard, Marilyn S. Albert, Rebecca A. Betensky, Deborah BlackerAbstract:BACKGROUND We have previously established the reliability and cross-sectional validity of the SIST-M (Structured Interview and Scoring Tool-Massachusetts Alzheimer's Disease Research Center), a shortened version of an instrument shown to predict progression to Alzheimer disease (AD), even among persons with very mild cognitive impairment (vMCI). OBJECTIVE To test the predictive validity of the SIST-M. METHODS Participants were 342 community-dwelling, nondemented older adults in a longitudinal study. Baseline Clinical Dementia Rating (CDR) Ratings were determined by either (1) clinician interviews or (2) a previously developed computer algorithm based on 60 questions (of a possible 131) extracted from clinician interviews. We developed age+sex+education-adjusted Cox proportional hazards models using CDR-sum-of-boxes (CDR-SB) as the predictor, where CDR-SB was determined by either a clinician interview or an algorithm; models were run for the full sample (n = 342) and among those jointly classified as vMCI using clinician-based and algorithm-based CDR Ratings (n = 156). We directly compared predictive accuracy using time-dependent receiver opeRating characteristic (ROC) curves. RESULTS AD hazard ratios (HRs) were similar for clinician-based and algorithm-based CDR-SB: for a 1-point increment in CDR-SB, the respective HRs [95% confidence interval (CI)] were 3.1 (2.5, 3.9) and 2.8 (2.2, 3.5); among those with vMCI, the respective HRs (95% CI) were 2.2 (1.6, 3.2) and 2.1 (1.5, 3.0). Similarly high predictive accuracy was achieved: the concordance probability (weighted average of the area-under-the-ROC curves) over follow-up was 0.78 versus 0.76 using clinician-based versus algorithm-based CDR-SB. CONCLUSION CDR scores based on items from this shortened interview had high predictive ability for AD-comparable to that using a lengthy Clinical interview.
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the structured interview scoring tool massachusetts alzheimer s disease research center sist m development reliability and cross sectional validation of a brief structured Clinical Dementia Rating interview
JAMA Neurology, 2011Co-Authors: Olivia I. Okereke, Maura Copeland, Bradley T. Hyman, Taylor Wanggaard, Marilyn S. Albert, Deborah BlackerAbstract:Background The Clinical Dementia Rating (CDR) and CDR Sum-of-Boxes can be used to grade mild but Clinically important cognitive symptoms of Alzheimer disease. However, sensitive Clinical interview formats are lengthy. Objectives To develop a brief instrument for obtaining CDR scores and to assess its reliability and cross-sectional validity. Methods Using legacy data from expanded interviews conducted among 347 community-dwelling older adults in a longitudinal study, we identified 60 questions (from a possible 131) about cognitive functioning in daily life using Clinical judgment, inter-item correlations, and principal components analysis. Items were selected in 1 cohort (n = 147), and a computer algorithm for geneRating CDR scores was developed in this same cohort and re-run in a replication cohort (n = 200) to evaluate how well the 60 items retained information from the original 131 items. Short interviews based on the 60 items were then administered to 50 consecutively recruited older individuals, with no symptoms or mild cognitive symptoms, at an Alzheimer's Disease Research Center. Clinical Dementia Rating scores based on short interviews were compared with those from independent long interviews. Results In the replication cohort, agreement between short and long CDR interviews ranged from κ = 0.65 to 0.79, with κ = 0.76 for Memory, κ = 0.77 for global CDR, and intraclass correlation coefficient for CDR Sum-of-Boxes = 0.89. In the cross-sectional validation, short interview scores were slightly lower than those from long interviews, but good agreement was observed for global CDR and Memory (κ ≥ 0.70) as well as for CDR Sum-of-Boxes (intraclass correlation coefficient = 0.73). Conclusion The Structured Interview & Scoring Tool–Massachusetts Alzheimer's Disease Research Center is a brief, reliable, and sensitive instrument for obtaining CDR scores in persons with symptoms along the spectrum of mild cognitive change.
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The Structured Interview & Scoring Tool–Massachusetts Alzheimer's Disease Research Center (SIST-M): Development, Reliability, and Cross-Sectional Validation of a Brief Structured Clinical Dementia Rating Interview
Archives of neurology, 2011Co-Authors: Olivia I. Okereke, Maura Copeland, Bradley T. Hyman, Taylor Wanggaard, Marilyn S. Albert, Deborah BlackerAbstract:Background The Clinical Dementia Rating (CDR) and CDR Sum-of-Boxes can be used to grade mild but Clinically important cognitive symptoms of Alzheimer disease. However, sensitive Clinical interview formats are lengthy. Objectives To develop a brief instrument for obtaining CDR scores and to assess its reliability and cross-sectional validity. Methods Using legacy data from expanded interviews conducted among 347 community-dwelling older adults in a longitudinal study, we identified 60 questions (from a possible 131) about cognitive functioning in daily life using Clinical judgment, inter-item correlations, and principal components analysis. Items were selected in 1 cohort (n = 147), and a computer algorithm for geneRating CDR scores was developed in this same cohort and re-run in a replication cohort (n = 200) to evaluate how well the 60 items retained information from the original 131 items. Short interviews based on the 60 items were then administered to 50 consecutively recruited older individuals, with no symptoms or mild cognitive symptoms, at an Alzheimer's Disease Research Center. Clinical Dementia Rating scores based on short interviews were compared with those from independent long interviews. Results In the replication cohort, agreement between short and long CDR interviews ranged from κ = 0.65 to 0.79, with κ = 0.76 for Memory, κ = 0.77 for global CDR, and intraclass correlation coefficient for CDR Sum-of-Boxes = 0.89. In the cross-sectional validation, short interview scores were slightly lower than those from long interviews, but good agreement was observed for global CDR and Memory (κ ≥ 0.70) as well as for CDR Sum-of-Boxes (intraclass correlation coefficient = 0.73). Conclusion The Structured Interview & Scoring Tool–Massachusetts Alzheimer's Disease Research Center is a brief, reliable, and sensitive instrument for obtaining CDR scores in persons with symptoms along the spectrum of mild cognitive change.
Olivia I. Okereke - One of the best experts on this subject based on the ideXlab platform.
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The SIST-M: Predictive validity of a brief structured Clinical Dementia Rating interview
Alzheimer disease and associated disorders, 2012Co-Authors: Olivia I. Okereke, Norberto Pantoja-galicia, Maura Copeland, Bradley T. Hyman, Taylor Wanggaard, Marilyn S. Albert, Rebecca A. Betensky, Deborah BlackerAbstract:BACKGROUND We have previously established the reliability and cross-sectional validity of the SIST-M (Structured Interview and Scoring Tool-Massachusetts Alzheimer's Disease Research Center), a shortened version of an instrument shown to predict progression to Alzheimer disease (AD), even among persons with very mild cognitive impairment (vMCI). OBJECTIVE To test the predictive validity of the SIST-M. METHODS Participants were 342 community-dwelling, nondemented older adults in a longitudinal study. Baseline Clinical Dementia Rating (CDR) Ratings were determined by either (1) clinician interviews or (2) a previously developed computer algorithm based on 60 questions (of a possible 131) extracted from clinician interviews. We developed age+sex+education-adjusted Cox proportional hazards models using CDR-sum-of-boxes (CDR-SB) as the predictor, where CDR-SB was determined by either a clinician interview or an algorithm; models were run for the full sample (n = 342) and among those jointly classified as vMCI using clinician-based and algorithm-based CDR Ratings (n = 156). We directly compared predictive accuracy using time-dependent receiver opeRating characteristic (ROC) curves. RESULTS AD hazard ratios (HRs) were similar for clinician-based and algorithm-based CDR-SB: for a 1-point increment in CDR-SB, the respective HRs [95% confidence interval (CI)] were 3.1 (2.5, 3.9) and 2.8 (2.2, 3.5); among those with vMCI, the respective HRs (95% CI) were 2.2 (1.6, 3.2) and 2.1 (1.5, 3.0). Similarly high predictive accuracy was achieved: the concordance probability (weighted average of the area-under-the-ROC curves) over follow-up was 0.78 versus 0.76 using clinician-based versus algorithm-based CDR-SB. CONCLUSION CDR scores based on items from this shortened interview had high predictive ability for AD-comparable to that using a lengthy Clinical interview.
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the structured interview scoring tool massachusetts alzheimer s disease research center sist m development reliability and cross sectional validation of a brief structured Clinical Dementia Rating interview
JAMA Neurology, 2011Co-Authors: Olivia I. Okereke, Maura Copeland, Bradley T. Hyman, Taylor Wanggaard, Marilyn S. Albert, Deborah BlackerAbstract:Background The Clinical Dementia Rating (CDR) and CDR Sum-of-Boxes can be used to grade mild but Clinically important cognitive symptoms of Alzheimer disease. However, sensitive Clinical interview formats are lengthy. Objectives To develop a brief instrument for obtaining CDR scores and to assess its reliability and cross-sectional validity. Methods Using legacy data from expanded interviews conducted among 347 community-dwelling older adults in a longitudinal study, we identified 60 questions (from a possible 131) about cognitive functioning in daily life using Clinical judgment, inter-item correlations, and principal components analysis. Items were selected in 1 cohort (n = 147), and a computer algorithm for geneRating CDR scores was developed in this same cohort and re-run in a replication cohort (n = 200) to evaluate how well the 60 items retained information from the original 131 items. Short interviews based on the 60 items were then administered to 50 consecutively recruited older individuals, with no symptoms or mild cognitive symptoms, at an Alzheimer's Disease Research Center. Clinical Dementia Rating scores based on short interviews were compared with those from independent long interviews. Results In the replication cohort, agreement between short and long CDR interviews ranged from κ = 0.65 to 0.79, with κ = 0.76 for Memory, κ = 0.77 for global CDR, and intraclass correlation coefficient for CDR Sum-of-Boxes = 0.89. In the cross-sectional validation, short interview scores were slightly lower than those from long interviews, but good agreement was observed for global CDR and Memory (κ ≥ 0.70) as well as for CDR Sum-of-Boxes (intraclass correlation coefficient = 0.73). Conclusion The Structured Interview & Scoring Tool–Massachusetts Alzheimer's Disease Research Center is a brief, reliable, and sensitive instrument for obtaining CDR scores in persons with symptoms along the spectrum of mild cognitive change.
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The Structured Interview & Scoring Tool–Massachusetts Alzheimer's Disease Research Center (SIST-M): Development, Reliability, and Cross-Sectional Validation of a Brief Structured Clinical Dementia Rating Interview
Archives of neurology, 2011Co-Authors: Olivia I. Okereke, Maura Copeland, Bradley T. Hyman, Taylor Wanggaard, Marilyn S. Albert, Deborah BlackerAbstract:Background The Clinical Dementia Rating (CDR) and CDR Sum-of-Boxes can be used to grade mild but Clinically important cognitive symptoms of Alzheimer disease. However, sensitive Clinical interview formats are lengthy. Objectives To develop a brief instrument for obtaining CDR scores and to assess its reliability and cross-sectional validity. Methods Using legacy data from expanded interviews conducted among 347 community-dwelling older adults in a longitudinal study, we identified 60 questions (from a possible 131) about cognitive functioning in daily life using Clinical judgment, inter-item correlations, and principal components analysis. Items were selected in 1 cohort (n = 147), and a computer algorithm for geneRating CDR scores was developed in this same cohort and re-run in a replication cohort (n = 200) to evaluate how well the 60 items retained information from the original 131 items. Short interviews based on the 60 items were then administered to 50 consecutively recruited older individuals, with no symptoms or mild cognitive symptoms, at an Alzheimer's Disease Research Center. Clinical Dementia Rating scores based on short interviews were compared with those from independent long interviews. Results In the replication cohort, agreement between short and long CDR interviews ranged from κ = 0.65 to 0.79, with κ = 0.76 for Memory, κ = 0.77 for global CDR, and intraclass correlation coefficient for CDR Sum-of-Boxes = 0.89. In the cross-sectional validation, short interview scores were slightly lower than those from long interviews, but good agreement was observed for global CDR and Memory (κ ≥ 0.70) as well as for CDR Sum-of-Boxes (intraclass correlation coefficient = 0.73). Conclusion The Structured Interview & Scoring Tool–Massachusetts Alzheimer's Disease Research Center is a brief, reliable, and sensitive instrument for obtaining CDR scores in persons with symptoms along the spectrum of mild cognitive change.
Rachelle S. Doody - One of the best experts on this subject based on the ideXlab platform.
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Staging Dementia Using Clinical Dementia Rating Scale Sum of Boxes Scores
2016Co-Authors: Sid E. O'bryant, Stephen C. Waring, C. Munro Cullum, Laura H. Lacritz, Paul J. Massman, Philip J. Lupo, Joan S. Reisch, Rachelle S. DoodyAbstract:Background—The Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB) score is commonly used, although the utility regarding this score in staging Dementia severity is not well established. Obiective—To investigate the effectiveness of CDRSOB scores in staging Dementia severity compared with the global CDR score. Design—Retrospective study. Setting—Texas Alzheimer's Research Consortium minimum data set cohort. Participants—A total of 1577 participants (110 controls, 202 patients with mild cognitive impairment, and 1265 patients with probable Alzheimer disease) were available for analysis. Main Outcome Measures—Receiver opeRating characteristic curves were generated from a derivation sample to determine optimal cutoff scores and ranges, which were then applied to the validation sample. © 2008 American Medical Association. All rights reserved Correspondence: Sid E. O'Bryant, PhD, Department of Neuropsychiatry and Behavioral Science, Texas Tech University Health Sciences Center, 3601 4th St, STOP 8321, Lubbock, TX 79430 (sid.obryant@ttuhsc.edu).. Author Contributions: Drs O'Bryant and Waring had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: O'Bryant, Waring, and Cullum. Acquisition of data: O'Bryant, Waring, Cullum, Hall, Lacritz, Reisch, and Doody. Analysis and interpretation of data: O'Bryant, Waring, Cullum, Massman, Lupo, Reisch, and Doody. Drafting of the manusctipt: O'Bryant, Waring, and Cullum. Critical revision of the manuscript for important intellectual content: O'Bryant, Waring, Cullum, Hall, Lacritz, Massman, Lupo, Reisch, and Doody. Statistical analysis: O'Bryant, Waring, Massman, Lupo, and Reisch. Texas Alzheimer's Research Consortium Investigators: Violeta Capriles, MD, MPH, Eveleen Darby, MA, MS, Kinga Szigeti, MD, PhD, Baylor College of Medicine, Houston, Texas; Randolph Schiffer, MD, Merena Tindall, RN, Patricia Sutker, PhD, Yan Zhang, PhD, Texas Tech University Health Sciences Center, Lubbock; Jessica Alexander, BA, Thomas Fairchild, PhD, Janice Knebl, DO, Douglas Mains, PhD, University of North Texas Health Science Center, Fort Worth; Ramon Diaz-Arrastia, MD, PhD, Joey Naylor, BA, Roger Rosenberg, MD, Doris Svetlik, RN, Keverly Williams, BA, University of Texas Southwestern Medical Center, Dallas. Financial Disclosure: None reported. NIH Public Access Author Manuscript Arch Neurol. Author manuscript; available in PMC 2012 August 01. Published in final edited form as: Arch Neurol. 2008 August ; 65(8): 1091–1095. doi:10.1001/archneur.65.8.1091. N IH PA Athor M anscript N IH PA Athor M anscript N IH PA Athor M anscript Results—Optimal ranges of CDR-SOB scores corresponding to the global CDR scores were 0.5 to 4.0 for a global score of 0.5, 4.5 to 9.0 for a global score of 1.O, 9.5 to 15.5 for a global score of 2.0, and 16.0 to 18.0 for a global score of 3.0. When applied to the validation sample, κ scores ranged from 0.86 to 0.94 (P
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staging Dementia using Clinical Dementia Rating scale sum of boxes scores
2016Co-Authors: Sid E Obryant, Stephen C. Waring, Laura H. Lacritz, Paul J. Massman, Philip J. Lupo, Joan S. Reisch, Munro C Cullum, Rachelle S. DoodyAbstract:Background—The Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB) score is commonly used, although the utility regarding this score in staging Dementia severity is not well established. Obiective—To investigate the effectiveness of CDRSOB scores in staging Dementia severity compared with the global CDR score. Design—Retrospective study. Setting—Texas Alzheimer's Research Consortium minimum data set cohort. Participants—A total of 1577 participants (110 controls, 202 patients with mild cognitive impairment, and 1265 patients with probable Alzheimer disease) were available for analysis. Main Outcome Measures—Receiver opeRating characteristic curves were generated from a derivation sample to determine optimal cutoff scores and ranges, which were then applied to the validation sample. © 2008 American Medical Association. All rights reserved Correspondence: Sid E. O'Bryant, PhD, Department of Neuropsychiatry and Behavioral Science, Texas Tech University Health Sciences Center, 3601 4th St, STOP 8321, Lubbock, TX 79430 (sid.obryant@ttuhsc.edu).. Author Contributions: Drs O'Bryant and Waring had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: O'Bryant, Waring, and Cullum. Acquisition of data: O'Bryant, Waring, Cullum, Hall, Lacritz, Reisch, and Doody. Analysis and interpretation of data: O'Bryant, Waring, Cullum, Massman, Lupo, Reisch, and Doody. Drafting of the manusctipt: O'Bryant, Waring, and Cullum. Critical revision of the manuscript for important intellectual content: O'Bryant, Waring, Cullum, Hall, Lacritz, Massman, Lupo, Reisch, and Doody. Statistical analysis: O'Bryant, Waring, Massman, Lupo, and Reisch. Texas Alzheimer's Research Consortium Investigators: Violeta Capriles, MD, MPH, Eveleen Darby, MA, MS, Kinga Szigeti, MD, PhD, Baylor College of Medicine, Houston, Texas; Randolph Schiffer, MD, Merena Tindall, RN, Patricia Sutker, PhD, Yan Zhang, PhD, Texas Tech University Health Sciences Center, Lubbock; Jessica Alexander, BA, Thomas Fairchild, PhD, Janice Knebl, DO, Douglas Mains, PhD, University of North Texas Health Science Center, Fort Worth; Ramon Diaz-Arrastia, MD, PhD, Joey Naylor, BA, Roger Rosenberg, MD, Doris Svetlik, RN, Keverly Williams, BA, University of Texas Southwestern Medical Center, Dallas. Financial Disclosure: None reported. NIH Public Access Author Manuscript Arch Neurol. Author manuscript; available in PMC 2012 August 01. Published in final edited form as: Arch Neurol. 2008 August ; 65(8): 1091–1095. doi:10.1001/archneur.65.8.1091. N IH PA Athor M anscript N IH PA Athor M anscript N IH PA Athor M anscript Results—Optimal ranges of CDR-SOB scores corresponding to the global CDR scores were 0.5 to 4.0 for a global score of 0.5, 4.5 to 9.0 for a global score of 1.O, 9.5 to 15.5 for a global score of 2.0, and 16.0 to 18.0 for a global score of 3.0. When applied to the validation sample, κ scores ranged from 0.86 to 0.94 (P <.001 for all), with 93.0% of the participants falling within the new staging categories. Conclusions—The CDR-SOB score compares well with the global CDR score for Dementia staging. Owing to the increased range of values, the CDR-SOB score offers several advantages over the global score, including increased utility in tracking changes within and between stages of Dementia severity. Interpretive guidelines for CDR-SOB scores are provided. Staging of Alzheimer Disease (AD) severity via global assessment measures is commonplace in Clinical and research settings and is useful for many reasons. Clinically, knowledge of Dementia severity is helpful for rapid communication about the disease, for making management decisions, and for selection of pharmacologic options that have been approved for different levels of diseas severity.1–3 In research settings, staging of Dementia severity is valuable for operationally defining homogeneous patient populations for comparison purposes and end points for research studies monitoring progression.2 In addition, staging of Dementia severity is critical for Clinical trials, as outlined by the US Food and Drug Administration's Guidelines for the Clinical Evaluation of AntiDementia Drugs,4(p15) which states that the stage and severity of the Dementia affecting each subject participating in a Clinical trial must be assessed and recorded systematically in a manner that will be readily understood by other workers in the field. The Washington University Clinical Dementia Rating Scale (CDR) is a global assessment instrument that yields global and Sum of Boxes (SOB) scores, with the global score regularly used in Clinical and research settings to stage Dementia severity.5 Although the CDR-SOB score has been considered a more detailed quantitative general index than the global score6 and provides more information than the global CDR score in patients with mild Dementia,7 its utility in formally staging Dementia severity remains untested. The utilization of CDR-SOB scores for staging Dementia severity offers several advantages over the global score because the optimal characteristics of both scores can be combined into a single score. First, CDR-SOB scores are much simpler to calculate than the global score and they do not require an algorithm for computation, which will ultimately result in fewer calculation errors for those not using the online system. Second, CDR-SOB scores can be treated as interval data in statistical analyses, whereas global CDR scores are ordinal by the nature of the algorithm approach to condensing the data. Finally, the most significant advantage to using CDR-SOB scores for staging of Dementia severity is the increased precision afforded for tracking changes across time. This study was designed to evaluate the utility of CDRSOB scores in staging AD severity compared with the global CDR score and to provide interpretive guidelines for CDRSOB scores. It was hypothesized that CDR-SOB scores would correctly stage many participants in the present study. Next, we evaluated the utility of CDR-SOB scores in distinguishing between patients diagnosed as having mild cognitive impairment (MCI) vs those diagnosed as having very early AD. It was hypothesized that CDR-SOB scores would accurately predict diagnosis (MCI or AD) in most patients with global CDR scores of 0.5. METHODS PARTICIPANTS The Texas Alzheimer's Research Consortium (TARC) is a statefunded collaborative group of investigators from Baylor College of Medicine, Texas Tech University Health Sciences O'Bryant et al. Page 2 Arch Neurol. Author manuscript; available in PMC 2012 August 01. N IH PA Athor M anscript N IH PA Athor M anscript N IH PA Athor M anscript Center, University of North Texas Health Science Center, and University of Texas Southwestern Medical Center. The TARC database includes a retrospective minimum data set containing Clinical and demographic data on individuals enrolled since 2001 in AD research programs at TARC member sites and was patterned after the National Alzheimer's Coordinating Center minimum data set. The present study conlprises 1577 participants (110 controls, 202 patients with MCI, and 1265 patients with probable AD) from the TARC minimum data set who had available demographic data and CDR global and SOB scores at the initial visit. The breakdown of global CDR scores was as follows: CDR 0, 112 individuals (110 controls and 2 patients with MCI); CDR O.5, 457 individuals (196 with MCI and 261 with AD); CDR 1, 582 individuals (4 with MCI and 578 with AD); CDR 2, 304 individuals (all with AD); and CDR 3. 122 individuals (all with AD). All the participants met consensusbased diagnoses based on the following criteria: patients with AD met criteria of the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Alzheimers Disease and Related Disorders Association Work Group classification of probable AD,8 patients with MCI met the Mayo Clinic research criteria,9 and controls performed within normal limits on psychometric assessment and were assigned a global CDR score of 0. The CDR scores were assigned independent of consensus diagnosis.
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Greater precision when measuring Dementia severity: establishing item parameters for the Clinical Dementia Rating Scale.
Dementia and geriatric cognitive disorders, 2012Co-Authors: Deborah A. Lowe, Tyler M. Miller, Steve Balsis, Jared F. Benge, Rachelle S. DoodyAbstract:Background/Aims: An item response theory (IRT)-based scoring approach to the Clinical Dementia Rating Scale (CDR) can account for the pattern of scores across the CDR items (domains) and their differential abilities to indicate Dementia severity. In doing so, an IRT-based approach can provide greater precision than other CDR scoring algorithms. However, neither a good set of item parameters nor an easily digestible set of instructions needed to implement this approach is readily available. Methods: Participants were 1,326 patients at the Baylor College of Medicine Alzheimer’s Disease and Memory Disorders Clinic. Results: The item parameters necessary for an IRT-based scoring approach were identified (a parameters ranged from 3.01 to 6.22; b parameters ranged from –2.46 to 2.07). Conclusion: This study provides, and demonstrates how to easily apply, IRT-based item parameters for the CDR.
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Item Response Theory Reveals Variability of Functional Impairment within Clinical Dementia Rating Scale Stages
Dementia and geriatric cognitive disorders, 2011Co-Authors: Tyler M. Miller, Steve Balsis, Deborah A. Lowe, Jared F. Benge, Rachelle S. DoodyAbstract:Background/Aims:To investigate whether an item response theory (IRT) approach to measuring variations of Dementia severity within Clinical Dementia Rating (CDR) stages is associated with activities of daily living (ADLs). Methods: IRT estimates of Dementia severity within CDR stages in 1,181 patients were correlated with ADLs and analyzed. Results: IRT-determined Dementia severity was significantly correlated with ADLs in three of four impaired Dementia stages. Conclusion: An IRT approach shows considerable advantages over traditional scoring practices of the CDR not only because it increases precision in Dementia measurement, but also because it enables one to discover more precise associations with functional outcomes such as ADLs.
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staging Dementia using Clinical Dementia Rating scale sum of boxes scores a texas alzheimer s research consortium study
JAMA Neurology, 2008Co-Authors: Sid E Obryant, Stephen C. Waring, Laura H. Lacritz, Paul J. Massman, Philip J. Lupo, Joan S. Reisch, Munro C Cullum, James Hall, Rachelle S. DoodyAbstract:Background The Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB) score is commonly used, although the utility regarding this score in staging Dementia severity is not well established. Objective To investigate the effectiveness of CDR-SOB scores in staging Dementia severity compared with the global CDR score. Design Retrospective study. Setting Texas Alzheimer's Research Consortium minimum data set cohort. Participants A total of 1577 participants (110 controls, 202 patients with mild cognitive impairment, and 1265 patients with probable Alzheimer disease) were available for analysis. Main Outcome Measures Receiver opeRating characteristic curves were generated from a derivation sample to determine optimal cutoff scores and ranges, which were then applied to the validation sample. Results Optimal ranges of CDR-SOB scores corresponding to the global CDR scores were 0.5 to 4.0 for a global score of 0.5, 4.5 to 9.0 for a global score of 1.0, 9.5 to 15.5 for a global score of 2.0, and 16.0 to 18.0 for a global score of 3.0. When applied to the validation sample, κ scores ranged from 0.86 to 0.94 ( P Conclusions The CDR-SOB score compares well with the global CDR score for Dementia staging. Owing to the increased range of values, the CDR-SOB score offers several advantages over the global score, including increased utility in tracking changes within and between stages of Dementia severity. Interpretive guidelines for CDR-SOB scores are provided.
Kenichi Meguro - One of the best experts on this subject based on the ideXlab platform.
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Qualitative Assessment of Instrumental Activities of Daily Living in Older Persons with Very Mild Dementia: The Kurihara Project.
Dementia and geriatric cognitive disorders extra, 2016Co-Authors: Yoshitaka Ouchi, Kei Nakamura, Masahiro Nakatsuka, Mari Kasai, Kenichi MeguroAbstract:Background/Aims: We investigated quantitative/qualitative changes of instrumental activities of daily living (IADL) in people with a Clinical Dementia Rating (CDR
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A Cluster Randomized Controlled Trial of Nonpharmacological Interventions for Old-Old Subjects with a Clinical Dementia Rating of 0.5: The Kurihara Project
Dementia and geriatric cognitive disorders extra, 2015Co-Authors: Masahiro Nakatsuka, Kei Nakamura, Ryo Hamanosono, Yumi Takahashi, Mari Kasai, Yuko Sato, Teiko Suto, Ryoichi Nagatomi, Kenichi MeguroAbstract:Background: Evidence as to the benefits of nonpharmacological interventions for the boundary state between normal aging and Dementia [mild cognitive impairment or a Clinical Dementia Rating (CDR) of 0.5] remains weak due to a lack of positive controls. Aims: To directly compare the effects of cognitive interventions (CI), physical activities (PA) and a group reminiscence approach (GRA), we conducted a pilot study on the basis of a cluster randomized controlled trial design. Method: A total of 127 participants aged >74 years with a CDR of 0.5 were cluster randomized into three groups for CI, PA and GRA. The intervention lasted 12 weeks and consisted of weekly group sessions and home assignments. Mini-Mental State Examination (MMSE), Trail Making Test part A (TMT-A), word fluency (WF), 6-meter walk time and Quality of Life (QOL) Face Scale scores were evaluated as primary outcomes. Results: Methodology-related benefits of CI and PA were found for MMSE scores and walk time, respectively. TMT-A, WF and QOL Face Scale scores improved irrespective of the methodologies used. Conclusions: Our findings suggest that CI and PA may be beneficial to cognitive and physical abilities, respectively. Executive functions and QOL may improve irrespective of the intervention methodologies used.
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Impaired memory and executive function associated with decreased medial temporal and prefrontal blood flow in Clinical Dementia Rating 0.5 status : the Osaki-Tajiri project
Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society, 2012Co-Authors: Kentaro Inoue, Kenichi Meguro, Satoshi Yamaguchi, Mitsue Meguro, Kyoko Akanuma, Hiroshi FukudaAbstract:Aim: The Clinical Dementia Rating (CDR) is an assessment of Dementia severity based on observations of activities of daily living, and a CDR of 0.5 (CDR 0.5) represents questionable Dementia. A combination of the Cognitive Abilities Screening Instrument (CASI) and the Trail Making Test (TMT) scores discriminated CDR 0.5 subjects from healthy participants with a high degree of accuracy. We investigated the neurological background of CDR 0.5 subjects by correlating CASI and TMT scores with regional cerebral blood flow (rCBF) as measured by single photon emission computed tomography (SPECT). Methods: From a community-based cohort, 22 CDR 0.5 participants were recruited. CASI and TMT scores, rCBF measure using [123I]-N-isopropyl-p-iodoamphetamine and SPECT were obtained. We evaluated the relationships between the CASI domain scores, between TMT scores and rCBF in a regions-of-interest-based analysis, and voxel-based analysis using Statistical Parametric Mapping 5 software. Results: We found that lower rCBF in the left medial temporal cortex correlated with a decreased CASI domain recent memory score both in the regions-of-interest and statistical parametric mapping analysis. In both the regions-of-interest and statistical parametric mapping analysis, the rCBF in the left prefrontal cortex correlated with CASI domain remote memory and mental manipulation and concentration. Conclusions: Our results indicate that some CDR 0.5 subjects have functional impairments in the medial temporal lobe as well as in the prefrontal cortex, as reflected in the cognitive decline measured by CASI and TMT.
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combined memory and executive function tests can screen mild cognitive impairment and converters to Dementia in a community the osaki tajiri project
Neuroepidemiology, 2009Co-Authors: Eriko Nakata, Hiroshi Ishii, Satoshi Yamaguchi, Mitsue Meguro, Masashi Kasuya, Mari Kasai, Kyoko Akanuma, Kenichi MeguroAbstract:Background: The borderline condition between health and Dementia, defined as Clinical Dementia Rating (CDR) 0.5, should be detected for the possible prediction of Dementia. Since th
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Normative data on Benton Visual Form Discrimination Test for older adults and impaired scores in Clinical Dementia Rating 0.5 participants: community-based study. The Osaki-Tajiri Project.
Psychiatry and clinical neurosciences, 2009Co-Authors: Mari Kasai, Hiroshi Ishii, Satoshi Yamaguchi, Junichi Ishizaki, Atsushi Yamadori, Kenichi MeguroAbstract:Aims: The Benton Visual Form Discrimination test (VFD) is one of the non-verbal tests to assess the capacity for complex visual form discrimination. The purposes of the present study were to investigate the effects of age and education level of the VFD in healthy elderly subjects, rigorously excluding participants with Clinical Dementia Rating (CDR) 0.5, and the characteristics of VFD patterns in CDR 0.5 participants. Methods: The 597 participants included CDR 0 (healthy elderly, n = 405), CDR 0.5 (mild cognitive impairment, n = 161), and CDR 1 and 2 (Dementia, n = 31). The VFD, Digit Forwards, Digit Backwards and Rey–Osterrieth Complex Figure Test (RCFT) copying were used for neuropsychological assessment. Results: There were significant effects of age and education level on the VFD in healthy participants, and the CDR 0.5 group had a lower score on the VFD than the healthy group. Low performance on the VFD was associated with Digit Backward and RCFT copying in both healthy and CDR 0.5 participants. Conclusions: CDR 0.5 participants exhibit deficits of visual form discrimination related to attention, visual construction and organization.